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SASTM Newsflash - The first imported human infection with avian influenza A (H7N9) confirmed in Taiwan

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The first imported human infection with avian influenza A(H7N9) confirmed in Taiwan

Travelers visiting areas affected by H7N9 advised to practice good personal hygiene, avoid touching and feeding live poultry, and avoid visiting traditional markets with live poultry

In the late afternoon of 24 Apr 2013, the Central Epidemic Command Center (CECC) confirmed the first imported case of H7N9 avian influenza in a 53-year-old male Taiwanese citizen who worked in Suzhou, Jiangsu Province, China prior to illness onset.He developed his illness 3 days after returning to Taiwan.Infection with avian influenza A (H7N9) was confirmed on 24 Apr 2013.The patient is currently in a severe condition and being treated in a negative-pressure isolation room [which ensures all air is exhausted through a HEPA (virus) filter.

Minister of Health, Dr. Wen-Ta Chiu, and Commander of CECC, Dr. Feng-Yee Chang, have full knowledge of the situation and have instructed implementation of subsequent prevention and control measures.In addition, CECC has reported the case to the World Health Organization through the IHR Focal Point.Furthermore, according to the Cross-strait Cooperation Agreement on Medicine and Public Health Affairs, CECC has also reported the case to the contact point in China.

CECC indicated that the case is a hepatitis B carrier with history of hypertension.Due to the fact that he worked in Suzhou, Jiangsu Province before his illness, he had been traveling back and forth regularly between Suzhou and Taiwan for a long time.During 28 March and 9 Apr 2013, the patient traveled to Suzhou.

On 9 April, he returned to Taiwan from Shanghai.According to the case, he had not been exposed to birds and poultry during his stay in Suzhou and had not consumed undercooked poultry or eggs.

On 12 April, he developed fever, sweating, and fatigue, but no respiratory or gastrointestinal symptoms.

On 16 April, he sought medical attention at a clinic when he developed high fever and was transferred to a hospital by the physician. He was then hospitalized in a single-patient room for further treatment. On 16 April, he was administered Tamiflu.

On 18 April, his chest x-ray showed interstitial infiltrate in the right lower lung.

On the night of 19 April, his conditions worsened.

On April 20, he was transferred to a medical center for further treatment. He was then intubated due to respiratory failure and placed in the negative-pressure isolation room in the intensive care unit. During his stay in the hospitals, 2 throat swab specimens were collected and both tested negative for avian influenza A (H7N9) virus by real-time RT-PCR.

On 22 April, the medical center collected a sputum specimen from the patient and the specimen was tested positive for influenza A.

In the morning of 24 April, avian influenza A (H7N9) virus was detected in the sputum specimen using real-time RT-PCR.In the later afternoon of April 24, the NationalInfluenzaCenter in Taiwan confirmed the identification and completed the genome sequencing of the virus.

At the time of writing, CECC has obtained the list of 139 people who have come into contact with the confirmed case, including 3 close contacts, 26 regular contacts (past the 7-day incubation period), and 110 healthcare workers, for investigation and follow-up activities. Of the 110 healthcare workers, 4 have passed the 7-day incubation period and shown no symptoms.Only 3 contacts failed to put on appropriate personal protective equipment when the contact occurred.Thus far, the 3 have not developed symptoms, but they will be followed up until 27 Apr 2013.

On the other hand, while delivering healthcare services, 3 healthcare workers who were geared with appropriate personal protective equipment developed symptoms of upper respiratory infection.The public health authority have conducted thorough health education activities for all contacts, issued them with "Self-Health Management Advice for H7N9 Influenza", and will be following up with them closely until the period of voluntary contact tracing is lifted.When a contact develops influenza-like illness symptoms such as fever and cough, the public health authority will voluntarily assist the individual in seeking medical attention.

CECC has continued to strengthen surveillance and fever screening of travelers arriving from China, especially areas with ongoing outbreaks of human infection with avian influenza A(H7N9), including Shanghai, Jiangsu, Zhejiang, Anhui, Beijing, Henan and Shandong.Physicians are once again reminded to report suspected cases to the health authority within 24 hours of detection according to the relevant regulation.

Before the infection is confirmed, please manage the case according to the following: a suspect case-patient with severe respiratory infections should be hospitalized in isolation for treatment. A suspect case-patient with mild symptoms should be asked to conduct self-health management and put on a surgical mask, and provided with thorough health education.Further, specimens should be collected from the patient for laboratory testing and the need for administering antivirals should be determined.If human infection with avian influenza A (H7N9) is later confirmed, an appropriate hospital for isolation and treatment will be determined by the Regional Commander of CECC.

CECC once again urges travelers visiting China to practice good personal hygiene such as washing hands frequently and putting on a mask, take preventive measures such as avoiding direct contact with poultry and birds or their droppings, avoiding visiting traditional markets with live poultry, consuming only thoroughly cooked poultry and eggs.If symptoms such as fever and cough develop after returning to Taiwan, please put on a surgical mask and seek immediate medical attention.Moreover, please inform the physician of the recent travel history to facilitate diagnosis and treatment.

Communicated by: Promed Mail

This case was infected in the Shanghai area.There must be many more commuters like him being exposed on the mainland every day.

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The content and opinions are neither pre-screened nor endorsed by the SASTM. The content should neither be interpreted nor quoted as inherently accurate or authoritative.

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The information provided in SASTM Newsflashes is collected from various news sources, health agencies and government agencies. Although the information is believed to be accurate, any express or implied warranty as to its suitability for any purpose is categorically disclaimed. In particular, this information should not be construed to serve as medical advice for any individual. The health information provided is general in nature, and may not be appropriate for all persons. Medical advice may vary because of individual differences in such factors as health risks, current medical conditions and treatment, allergies, pregnancy and breast feeding, etc. In addition, global health risks are constantly evolving and changing. International travelers should consult a qualified physician for medical advice prior to departure.

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The SASTM’s Mission is to guide the profession in all aspects relating to the practice of travel medicine,
liaise with the travel industry, consult with relevant authorities,
advise the public and collaborate nationally and internationally on all aspects relating to Travel Medicine.

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